Orthodontic clinicians' attitudes and knowledge of dentogingival aesthetics: A cross-sectional survey of BOS members.

OBJECTIVE: To assess orthodontic clinicians' knowledge and attitudes towards dentogingival aesthetics and to explore characteristics that predict the knowledge of dentogingival aesthetics. DESIGN: Cross-sectional questionnaire. SETTING: On-line survey of members of the British Orthdontic Society. MATERIALS AND METHODS: An 11-item online questionnaire was sent to orthodontic practitioners for completion. The questionnaire covered respondent demographics and questions relating to both knowledge and attitudes towards dentogingival aesthetics (six parameters). Descriptive statistics were calculated for study characteristics and summary values for the survey items. Responses to the eight knowledge-based questions were converted to a binary outcome (correct and incorrect answer). The maximum score that could be achieved was eight. Multivariable modelling was used in order to examine associations between the study characteristics and the aggregate score. RESULTS: A total of 252 responses were obtained resulting in a response rate of 17%. Within this cohort, the respondents were primarily women (52.8%) and aged 30-40 years (35.7%). The mean score for the eight knowledge-based questions was 3.8 ± 1.8 (range = 0-8). Knowledge of the ideal gingival margin position of the anterior teeth was high (92.4%). Knowledge of the other five dentogingival aesthetic parameters was variable. In the multivariable analysis, lower knowledge scores were predicated by respondents who did not have a special interest in dental aesthetics (-0.54; 95% confidence interval [CI] = -1.01 to -0.07; P = 0.02), who could not recall attending courses, lectures or seminars on dental aesthetics in the past five years (-0.80; 95% CI = -1.43 to -0.17; P = 0.01) and with increasing age (-0.43; 95% CI = -0.62 to -0.23; P < 0.001). CONCLUSION: Knowledge of ideal dentogingival parameters is generally suboptimal among orthodontists in the UK. The reported lack of knowledge of the ideal dentogingival parameters may also influence respondents' attitudes towards the importance of dentogingival aesthetics. Further teaching or courses related to dentogingival aesthetics is desired by orthodontic clinicians.

Should we recommend early overjet reduction to prevent dental trauma?

There is an association between increased overjet and risk of trauma to the maxillary incisor teeth in children and adolescents. It would therefore seem sensible to recommend overjet reduction as early as possible to help reduce this risk. However, orthodontic outcomes are essentially the same whether you start treatment in the early or late mixed dentition, while early treatment carries a heavier burden on compliance - taking longer and involving more appointments. This article explores the complex association between early overjet reduction and dental trauma in the context of current best evidence. Careful case selection is advised when justifying early intervention for increased overjet based on reducing trauma risk.

Study protocol for the management of impacted maxillary central incisors: a multicentre randomised clinical trial: the iMAC Trial.

BACKGROUND: Failure of eruption of the maxillary permanent incisor teeth usually presents in the mixed dentition between the ages of 7 and 9 years. Missing and unerupted maxillary incisors can be regarded as unattractive and have a potentially negative impact on facial and dental aesthetics. The presence of a supernumerary tooth (or odontoma) is commonly responsible for failed eruption or impaction of the permanent maxillary incisors. The primary objective of this trial is to investigate the success of eruption associated with maxillary incisor teeth that have failed to erupt because of a supernumerary tooth in the anterior maxilla. METHODS: This protocol describes an interventional multicentre two-arm randomised clinical trial. Participants meeting the eligibility criteria will be randomised (unrestricted equal participant allocation [1:1]) to either space creation with an orthodontic appliance, removal of the supernumerary tooth and application of direct orthodontic traction or space creation with an orthodontic appliance, removal of the supernumerary tooth and monitoring. The primary outcome of this trial is to determine the prevalence of successfully erupted maxillary central permanent incisors at 6 months following removal of the supernumerary tooth. Secondary outcome measures include (1) the effect of initial tooth position (assessed radiographically) on time taken for the tooth to erupt, (2) time taken to align the unerupted tooth to the correct occlusal position, (3) gingival aesthetics and (4) changes in the self-reported Oral Health Related-Quality of Life (OHRQoL) (pre-and post-treatment). DISCUSSION: There is a lack of high-quality robust prospective studies comparing the effectiveness of interventions to manage this condition. Furthermore, the UK national clinical guidelines have highlighted a lack of definitive treatment protocols for the management of children who present with an unerupted maxillary incisor due to the presence of a supernumerary tooth. The results of this trial will inform future treatment guidelines for the management of this condition in young children. TRIAL REGISTRATION: ISRCTN Registry ISRCTN12709966 . Registered on 16 June 2022.

Do we get better outcomes from early treatment of Class III discrepancies?

Early orthodontic treatment in the mixed dentition aims to simplify definitive treatment in the permanent dentition. In Class III cases, this can be an effective strategy for the management of a local anterior crossbite, using either a removable or simple fixed appliance. For more significant Class III malocclusions, the decision to intervene early is a more difficult one. Traditionally, orthodontists in the UK have been reluctant to embark on early treatment in the presence of a skeletal Class III relationship but there is now some evidence that in selected cases, the use of protraction headgear can be a successful method of avoiding the need for later surgery. Although growth prediction in Class III cases is notoriously difficult, in the presence of maxillary retrognathia, the general dental practitioner should consider early referral of Class III cases to a specialist orthodontist.

How to appraise the literature: basic principles for the busy clinician - part 1: randomised controlled trials.

Critical appraisal is the process of carefully, judiciously and systematically examining research to adjudicate its trustworthiness and its value and relevance in clinical practice. The first part of this two-part series will discuss the principles of critically appraising randomised controlled trials. The second part will discuss the principles of critically appraising systematic reviews and meta-analyses.Evidence-based dentistry (EBD) is the integration of the dentist's clinical expertise, the patient's needs and preferences and the most current, clinically relevant evidence. Critical appraisal of the literature is an invaluable and indispensable skill that dentists should possess to help them deliver EBD.This article seeks to act as a refresher and guide for generalists, specialists and the wider readership, so that they can efficiently and confidently appraise research - specifically, randomised controlled trials - that may be pertinent to their daily clinical practice.

Camouflaging the permanent maxillary canine to substitute an absent lateral incisor - part 2: challenges and solutions.

The developmental absence of permanent maxillary lateral incisors is a common developmental anomaly and presents clinical challenges. The maxillary lateral incisor is the second most common developmentally absent tooth after the mandibular second premolar, therefore can present frequently in practice. Patients with hypodontia of the maxillary lateral incisor present clinical challenges in relation to function and aesthetics. In part one of this two-part series, we focused on the assessment, diagnosis and management. In this part, we will discuss some of the frequently encountered challenges in canine camouflage cases and possible solutions.

Camouflaging the permanent maxillary canine to substitute an absent lateral incisor - part 1: assessment and management.

There remains debate as to whether, when there is a missing maxillary lateral incisor, space should be orthodontically opened to allow for prosthetic replacement or closed to camouflage the canines to substitute the absent lateral incisor by recontouring and simple restorative procedures. Each case presents its own features which will help decision making. Treatment planning these cases is multifactorial in nature and the decision ultimately depends on factors such as the malocclusion; inter-arch and intra-arch relationship; and canine properties (size, colour and shape). The ideal treatment is the most conservative one that satisfies the individual's aesthetic and functional requirements. Often, but not always, it is therefore space closure with camouflaging of the canines as lateral incisors. Multidisciplinary planning and delivery of care is essential and 'mandatory' in the delivery of optimal outcomes. The first part of this two-part series will discuss the principles of assessment, diagnosis and management. The second part will discuss the challenges encountered and possible solutions.

Role of the general dental practitioner in managing the risks of orthodontic treatment.

The aim of this article is to outline the potential risks in orthodontic treatment and the general dental practitioner's role in reducing and managing such risks. The success of orthodontic treatment largely depends on patient understanding of the risk/benefit implications of the orthodontic treatment and all of the potential consequences involved in such treatment. A perfect blend of good case selection, sound clinical judgement and, more importantly, a patient's clear understanding of the potential risks involved and the treatment implications help minimise and manage potential hazards that occur during the course of the treatment.

Post-treatment cephalometric changes in adolescent patients with Class II malocclusion treated using two different functional appliance systems for an extended time period: a randomized clinical trial.

OBJECTIVES: To assess the post-treatment changes in Class II adolescent patients treated with two different functional appliances for an extended time period. DESIGN: Randomized clinical trial. SETTING: One university and one district general hospital in the UK. PARTICIPANTS: Caucasian adolescent patients with a Class II malocclusion. METHODS: Pairs of patients of similar age and gender were randomly allocated to one of two functional appliance systems, the Twin Block or Dynamax appliance. The appliances were used for 15 months full time. Changes were measured from lateral cephalograms taken at the start (T1) and at the end of treatment at 15 months (T2) and 30 months (T3). RESULTS: Hundred patients completed the trial, 52 Twin Block and 48 Dynamax. Mandibular forward movement was 3.5 mm (±2.5) in the Twin Block group and 1.7 mm (±2.1) in the Dynamax group (P < 0.01; T1-T2) and, subsequently, by 0.3 mm (±2.6) and 0.9 mm (±2.5), respectively (P = 0.3; T2-T3). Mandibular length increased by 6.3 mm (±2.7) in the Twin Block group and 4.0 mm (±2.5) in the Dynamax group (P < 0.01; T1-T2) with treatment and, subsequently, by 0.5 mm (±2.3) and 1.5 mm (±3.1; P = 0.05). Anterior face height increased in both groups. CONCLUSIONS: Treatment resulted in greater mandibular growth with the Twin Block than the Dynamax. In the follow-up period, there was less growth in the Twin Block group compared to the Dynamax. TRIAL REGISTRATION: This trial was not registered on any major database of clinical trial. PROTOCOL: The protocol was not published before the commencement of the trial but can be given on request.

Motivation, expectations and understanding of patients and their parents seeking orthodontic treatment in specialist practice.

OBJECTIVES: To determine patient and parent/guardian motivation, expectation and understanding of orthodontic treatment. DESIGN: A self-completion questionnaire survey of new patients referred for orthodontic assessment. SETTING: Specialist practices in Surrey and Berkshire (United Kingdom). PARTICIPANTS: A total of 500 questionnaires were issued (250 were issued to patients and 250 to parents). METHODS: The survey was based on a self-completed questionnaire which was issued at the assessment appointment. Both questionnaires were adapted and extended from originally validated questionnaires previously used in a hospital setting. Patients and parents were asked to complete separate anonymous questionnaires. The patient questionnaire consisted of 24 closed-ended questions divided into three domains: motivation; understanding; and expectation of orthodontic treatment. The parent questionnaire consisted of 13 questions covering the same three domains. RESULTS: The response rate for the patient and parent questionnaires was 95% and 91%, respectively. Forty-seven percent of the patients were aged 11-13 years. In 77% of cases, the referral was initiated by their dentist. Only 3% of patients thought there was nothing wrong with their teeth. There was a poor understanding of what a retainer is and for how long patients are expected to use it. CONCLUSIONS: Referral for orthodontic treatment was initiated by the patients' general dental practitioner in the majority of the cases. The anticipation of improved dental appearance was a prime motivating factor. Participants had realistic expectations and there was a good acceptance of appliances and dental extractions for orthodontic treatment. Nevertheless, both patients and parents/guardians were less well informed on the nature and duration of orthodontic retention.

Effects of supplemental vibrational force on space closure, treatment duration, and occlusal outcome: A multicenter randomized clinical trial.

INTRODUCTION: A multicenter parallel 3-arm randomized clinical trial was carried out in 3 university hospitals in the United Kingdom to investigate the effect of supplemental vibratory force on space closure and treatment outcome with fixed appliances. METHODS: Eighty-one subjects less than 20 years of age with mandibular incisor irregularity undergoing extraction-based fixed appliance treatment were randomly allocated to supplementary (20 minutes/day) use of an intraoral vibrational device (AcceleDent; OrthoAccel Technologies, Houston, Tex) (n = 29), an identical nonfunctional (sham) device (n = 25), or fixed-appliance only (n = 27). Space closure in the mandibular arch was measured from dental study casts taken at the start of space closure, at the next appointment, and at completion of space closure. Final records were taken at completion of treatment. Data were analyzed blindly on a per-protocol basis with descriptive statistics, 1-way analysis of variance, and linear regression modeling with 95% confidence intervals. RESULTS: Sixty-one subjects remained in the trial at start of space closure, with all 3 groups comparable for baseline characteristics. The overall median rate of initial mandibular arch space closure (primary outcome) was 0.89 mm per month with no difference for either the AcceleDent group (difference, -0.09 mm/month; 95% CI, -0.39 to 0.22 mm/month; P = 0.57) or the sham group (difference, -0.02 mm/month; 95% CI, -0.32 to 0.29 mm/month; P = 0.91) compared with the fixed only group. Similarly, no significant differences were identified between groups for secondary outcomes, including overall treatment duration (median, 18.6 months; P >0.05), number of visits (median, 12; P >0.05), and percentage of improvement in the Peer Assessment Rating (median, 90.0%; P >0.05). CONCLUSIONS: Supplemental vibratory force during orthodontic treatment with fixed appliances does not affect space closure, treatment duration, total number of visits, or final occlusal outcome. REGISTRATION: NCT02314975. PROTOCOL: The protocol was not published before trial commencement. FUNDING: AcceleDent units were donated by OrthoAccel Technologies; no contribution to the conduct or the writing of this study was made by the manufacturer.

A retrospective study comparing the loss of anchorage following the extraction of maxillary first or second premolars during orthodontic treatment with fixed appliances in adolescent patients.

INTRODUCTION: This retrospective study assessed the difference in anchorage loss using 3D superimposition of study models between cases treated with extraction of maxillary first premolars and maxillary second premolars carried out in orthodontic specialist practice. METHOD: Sixty subjects who have undergone extractions of either maxillary first or second premolars as part of their orthodontic treatment were selected. Eligibility criteria included patients with a Class I, mild Class II or III malocclusions, mild-to-moderate crowding with no anchorage reinforcement. Pre- and post-treatment maxillary dental study cases were scanned using a surface laser scanner to produced 3D digital images which were superimposed using areas of stability on the anterior hard palate. Anchorage loss was measured by the mesial movement of the maxillary first permanent molar. RESULTS: The mean mesial movement for the maxillary first molars, when adjusted for confounding factors was 4.7 mm (SD 1.6) in the maxillary first premolar extraction group and 4.6 mm (SD 1.6) in the maxillary second premolar extraction group. CONCLUSIONS: There is no difference in anchorage loss when comparing the extraction of the maxillary first premolars to the extraction maxillary second premolars.

YouTube™ as an information resource for orthognathic surgery.

OBJECTIVE: To investigate video content on YouTube™ related to orthognathic surgery. MATERIALS AND METHODS: YouTube™ was searched using the terms: orthognathic surgery; orthodontic surgery; jaw surgery; jaw corrective surgery. Inclusion criteria included English language; primary content orthognathic surgery and acceptable audio-visual quality. Videos were sorted into the top 50 for each search term by view-count and into an overall top 60 from the four searches. The following parameters were recorded for each video: number of views; likes; dislikes; source; primary intention. Each was classified according to information content as 'excellent', 'moderate' or 'poor'. A pre-determined list of orthognathic surgery-related information domains was also evaluated. RESULTS: The top 60 videos had a combined total of 6,986,141 views. Videos predominantly involved patients describing their personal experience (41.67%) with the majority positively biased (61.67%). Only 9.17% of videos were classified as having excellent general information content and 55.83% were rated as poor. Surgical procedures were described in 45% whilst the need for pre- and post-surgical orthodontics was discussed in 33% and 16%, respectively. Post-operative paraesthesia was discussed in 17.5% of videos outcome. CONCLUSIONS: Video content on YouTube™ relating to orthognathic surgery is substandard and patients should be advised to view it with caution.

Effect of supplemental vibrational force on orthodontically induced inflammatory root resorption: A multicenter randomized clinical trial.

INTRODUCTION: A multicenter parallel 3-arm randomized clinical trial was carried out in 1 university and 2 district hospitals in the United Kingdom to investigate the effect of supplemental vibrational force on orthodontically induced inflammatory root resorption (OIIRR) during the alignment phase of fixed appliance therapy. METHODS: Eighty-one subjects less than 20 years old with mandibular incisor irregularity undergoing extraction-based fixed-appliance treatment were randomly allocated to supplementary (20 minutes a day) use of an intraoral vibrational device (AcceleDent; OrthoAccel Technologies, Houston, Tex) (n = 29), an identical nonfunctional (sham) device (n = 25), or fixed appliances only (n = 27). OIIRR was measured blindly from long-cone periapical radiographs of the maxillary right central incisor taken at the start of treatment and the end of alignment when a 0.019 × 0.025-in stainless steel archwire was placed (mean follow-up, 201.6 days; 95% confidence interval [CI], 188.6-214.6 days). Data were analyzed blindly on a per-protocol basis because losses to follow-up were minimal, with descriptive statistics, 1-way analysis of variance, and univariable and multivariable regression modeling. RESULTS: Nine patients were excluded from the analysis; they were evenly distributed across the groups. Mean overall OIIRR measured among the 72 patients was 1.08 mm (95% CI, 0.89-1.27 mm). Multivariable regression indicated no significant difference in OIIRR for the AcceleDent (difference, 0.22 mm; 95% CI, -0.14-0.72; P = 0.184) and AcceleDent sham groups (difference, 0.29 mm; 95% CI, -0.15-0.99; P = 0.147) compared with the fixed-appliance-only group, after accounting for patient sex, age, malocclusion, extraction pattern, alignment time, maximum pain experienced, history of dentoalveolar trauma, and initial root length of the maxillary right central incisor. No other side-effects were recorded apart from pain and OIIRR. CONCLUSIONS: The use of supplemental vibrational force during the alignment phase of fixed appliance orthodontic treatment does not affect OIIRR associated with the maxillary central incisor. REGISTRATION: ClinicalTrials.gov (NCT02314975). PROTOCOL: The protocol was not published before trial commencement. FUNDING: Functional and sham AcceleDent units were donated by the manufacturer; there was no contribution to the conduct or the writing of this study.

Supplemental vibrational force does not reduce pain experience during initial alignment with fixed orthodontic appliances: a multicenter randomized clinical trial.

This prospective randomized trial investigated the effect of supplemental vibrational force on orthodontic pain during alignment with fixed-appliances. Eighty-one subjects < 20 years-old undergoing extraction-based fixed-appliance treatment were randomly allocated to supplementary (20-minutes/day) use of an intra-oral vibrational device (AcceleDent(®)) (n = 29); an identical non-functional (sham) device (n = 25) or fixed-appliances only (n = 27). Each subject recorded pain intensity (using a 100-mm visual-analogue scale) and intake of oral analgesia in a questionnaire, following appliance-placement (T1) and first-adjustment (T2) for 1-week (immediately-after, 4, 24, 72-hours and at 1-week). Mean maximum-pain for the total sample was 72.96 mm [SD 21.59; 95%CI 68.19-77.74 mm] with no significant differences among groups (P = 0.282). Subjects taking analgesics reported slightly higher maximum-pain although this was not significant (P = 0.170). The effect of intervention was independent of analgesia (P = 0.883). At T1 and T2, a statistically and clinically significant increase in mean pain was seen at 4 and 24-hours, declining at 72-hours and becoming insignificant at 1-week. For mean alignment-rate, pain-intensity and use of analgesics, no significant differences existed between groups (P > 0.003). The only significant predictor for mean pain was time. Use of an AcceleDent vibrational device had no significant effect on orthodontic pain or analgesia consumption during initial alignment with fixed appliances.

Perceived changes by peer group of social impact associated with combined orthodontic-surgical correction of class III malocclusion.

OBJECTIVES: Whereas the psychosocial benefits of orthognathic treatment for the individual patient are established, there is little data relating to social perceptions in relation to changes in facial appearance as a result of combined orthodontic and orthognathic treatment. This study aimed to investigate the social impact of combined orthodontic-orthognathic surgical correction for class III malocclusion in Caucasian subjects. METHODS: This cross-sectional study compared perceptions of facial appearance prior to and after orthognathic correction of class III malocclusion. Eighty undergraduate students were shown photographs of four Caucasian subjects (2 male and 2 female) pre- and post-orthognathic class III correction. Observers were asked to rate these subjects in relation to four different outcomes: (i) social competence (SC); (ii) intellectual ability (IA); (iii) psychological adjustment (PA); (iv) attractiveness. A mixed-model analysis of variance (ANOVA) was calculated to determine the effect of each variable. RESULTS: Statistically significant differences were found in ratings of the same face before and after treatment. After treatment, faces were rated as more psychologically adjusted, more sociable, more likely to be successful and more attractive; with the mean psychological adjustment rating being associated with the most change (before treatment=8.06 [SD 2.30]; after treatment=6.64 [SD 2.03], t=2.04, p<0.001). CONCLUSIONS: After combined orthodontic-orthognathic correction of class III malocclusion in Caucasians, individuals are rated by young adults as being better adjusted both psychologically and socially, more likely to be successful and more attractive.

Interceptive orthodontic treatment in bullied adolescents and its impact on self-esteem and oral-health-related quality of life.

The aim of this follow-up study was to measure the self-reported frequency and severity of bullying in orthodontic patients previously identified as being bullied, who have commenced interceptive orthodontic treatment, and to investigate the effect on an individual's self-esteem and oral-health-related quality of life (OHRQoL). Forty-three adolescents previously identified as being bullied due to the presence of a malocclusion were invited to take part in a follow-up study following commencement of orthodontic treatment at three UK Hospitals. Validated questionnaires were used to assess the self-reported frequency and severity of bullying, self-esteem and OHRQoL. The participation rate at follow-up was 63 per cent. Following commencement of orthodontic treatment, 21 (78 per cent) participants reported they were currently no longer being bullied due to the presence of their malocclusion. In comparison to their pre-treatment scores, participants reported fewer functional limitations (P = 0.013), decreased emotional (P < 0.001) and social impact (P < 0.001), and improved overall oral health (P = 0.03) and OHRQoL (P = 0.002). In addition, an improvement in functional limitations (P = 0.021), emotional (P = 0.008), social impact (P = 0.008) and OHRQoL (P = 0.02) was reported by participants who were no longer being bullied in comparison to those who continued to report bullying. There appears to be no effect on an individual's self-esteem. Orthodontic treatment may have a positive effect on adolescents experiencing bullying related to their malocclusion and their OHRQoL.

Use of the Clark Twin Block functional appliance with and without an upper labial bow: a randomized controlled trial.

OBJECTIVES: To compare dentoalveolar and skeletal changes in two groups of Class II division 1 patients treated with different designs of Clark's Twin Block (CTB), with (Group 1) or without (Group 2) an upper labial bow. MATERIALS AND METHODS: A randomized controlled trial was conducted in the Department of Orthodontics at the East Kent Hospitals University NHS Foundation Trust, UK. Sixty-two white subjects (aged 10-14 years at the start of treatment, minimum overjet > 6 mm, molar relationship at least ½ unit Class II) were recruited. Subjects were divided into age- and sex-matched pairs, were randomly allocated to treatment with either appliance design, and were treated for 12 months, at which time additional data were collected. RESULTS: Sixty participants were available for final data collection. The two groups were well matched with respect to age (mean 12.5 years in Group 1; 12.3 years in Group 2). No statistical difference was noted between groups for any dentoalveolar or skeletal variables measured. Both groups experienced a reduction in overjet as a result of maxillary incisor retroclination, mandibular incisor proclination, and forward positioning of the pogonion. Maxillary molar distalization, mandibular molar mesialization, and ANB reduction also occurred in both groups. CONCLUSIONS: The addition of a maxillary labial bow to the CTB has no influence on dentoalveolar or skeletal changes, or on rate of overjet reduction, in relation to appliance therapy.

Bullying in orthodontic patients and its relationship to malocclusion,self-esteem and oral health-related quality of life.

OBJECTIVES: To measure the self-reported frequency and severity of bullying amongst patients referred for orthodontic treatment and to investigate whether there is a relationship between levels of self-reported bullying, malocclusion and need for orthodontic treatment and an individual's self-esteem and oral health-related quality of life (OHRQoL). DESIGN AND SETTING: Cross-sectional study of an adolescent group referred for orthodontic assessment at three UK hospitals. SUBJECTS AND METHODS: Three hundred and thirty-six participants aged between 10 and 14 years were recruited. Validated questionnaires were used to measure the self-reported frequency and severity of bullying, self-esteem and OHRQoL. Orthodontic treatment need was assessed using IOTN. RESULTS: The prevalence of bullying was 12·8%. Being bullied was significantly associated with Class II Division 1 incisor relationship (P = 0·041),increased overbite (P = 0·023),increased overjet (P = 0·001)and a high need for orthodontic treatment assessed using AC IOTN (P = 0·014).Bullied participants also reported lower levels of social competence (P<0·001),athletic competence (P<0·001), physical appearance related self-esteem (P<0·001)and general self-esteem (P<0·001). Higher levels of oral symptoms (P = 0·032),functional limitations (P<0·001), emotional (P<0·001)and social impact (P<0·001) from their oral condition, resulting in a negative impact on overall OHRQoL (P<0·001),were also reported. CONCLUSIONS: Significant relationships exist between bullying and certain occlusal traits, self-esteem and OHRQoL.

Combined orthodontic-restorative management of maxillary central incisors lost following traumatic injury: a case report.

A history of traumatic dental injury to the maxillary central incisors during preadolescence or adolescence is common and may result in premature loss. Treatment options include prosthetic implant replacement, autotransplantation, and orthodontic space closure with direct composite recontouring. This case report describes the treatment of an adolescent girl who presented with a crowded Class I malocclusion complicated by a history of trauma to the maxillary central incisors. The treatment plan consisted of orthodontic space closure following loss of both maxillary central incisors and mandibular premolars. This case highlights that orthodontic space closure can be a valuable treatment option in selected Class I crowded and Class II uncrowded malocclusions, producing predictable and efficient results.